This open enrollment season, watch out for health insurance that sounds too good to be true


It took Kelly Macauley almost a year to realize that the health plan she bought when buying insurance coverage last October was not, in fact, insurance. Sure, some red flags popped up along the way, but when she called to complain, she said, she received explanations that sounded pretty reasonable and forced her to pay her monthly premiums of $700.

She said she was told her medical bills weren’t being paid because the hospital was submitting them incorrectly. That Jericho Share, the nonprofit that sent him a membership card that said “THIS IS NOT INSURANCE,” was just the underwriter of his policy, not the actual insurer. That she hadn’t received a welcome package because the company was saving paper and passing those savings on to customers.

Then this summer, the 62-year-old retired teacher who recently moved from the Philadelphia area to South Carolina, learned that her plan had only paid $120 of her hip replacement bill l last year, leaving him with a balance of over $40,000. She said she was assured the procedure would be covered when she sought insurance. But it turns out that the plan she bought wasn’t insurance at all, but rather part of what’s called a shared healthcare ministry.

Shared Health Care Ministries are an alternative to health insurance in which members agree to share medical costs. They are often faith-based and can be cheaper than traditional insurance, although they may not cover medical costs for their members, according to a Commonwealth Fund Report.

“It was never mentioned to me,” Macauley said. “I honestly believed I was buying legitimate medical insurance.”

Starting Nov. 1, millions of Americans will purchase health insurance for 2023 during a period known as “open enrollment.” Through the federal and state insurance marketsconsumers can purchase health insurance plans that comply with the Affordable Care Act and find out if they are eligible for financial assistance.

But experts warn that the rush to buy coverage also presents an opportunity for people selling alternative products, such as short-term health plans and shared healthcare ministries, which are often less expensive than full coverage but offer much less protection. Although these alternatives are themselves legal, experts warn that misleading marketing can steer consumers looking for comprehensive coverage toward purchasing health plans that exclude protections for pre-existing conditions and leave patients vulnerable to large medical bills.

“Now is a great time to seek out consumers who are looking for insurance and lead them down the wrong path,” said JoAnn Volkco-director of the Center for Health Insurance Reforms at Georgetown University.

Volk has identified telltale signs of this wrong path: if the person selling you a plan starts asking about your medical history, or refuses to send you information about the plan altogether, or agrees to provide this information only after you have given them your payment information. According to a Secret Shoppers Report 2021 on Deceptive Marketing Practices, which Volk co-authored, a broker incorrectly cited HIPAA, the law to protect patient privacy, as a reason not to share health plan information.

“Just made up stuff,” Volk said. “If you commit fraud, there are no limits.”

In a statement to KHN, Jericho Share spokesperson Mark Hubbard said the organization could not discuss Macauley’s case without his prior written approval, but did not tolerate any misrepresentation or unethical conduct. from its programs.

Nationwide, lawmakers and regulators are taking notice of how health care plans are sold. Chairman of the Senate Finance Committee Ron Wydena Democrat from Oregon, investigation of complaints on the marketing of Medicare Advantage plans. And in May, the Centers for Medicare & Medicaid Services noted that the complaints on Medicare Advantage and Medicare drug plan marketing practices have increased from 15,497 in 2020 to at least 39,617 in 2021.

‘Healthcare scams have increased exponentially,’ Delaware insurance commissioner says Trinidad Navarrewho also chairs the National Association of Insurance Commissioners Anti-Fraud Task Force.

Several factors are behind the increase, Navarro said. Rising health care prices can drive up the cost of regulated health plans, such as those that comply with the Affordable Care Act. Higher costs are causing more Americans to seek out cheaper alternatives that usually doesn’t offer as much coverage and can confuse consumers. These types of plans proliferated under the administration of President Donald TrumpNavarro said.

“I don’t want to sound political,” said Navarro, an elected Democrat, “but the previous presidential administration was really pushing lean plans and alternatives to the ACA, and I don’t necessarily think they understood the fraud. who was associated with these plans.

Finally, Navarro said, because states are the primary insurance regulators, cracking down on health care scams can be like playing a game of moles — when a state acts, scammers move to a another to open a shop.

To combat this tactic, Navarro said, insurance regulators nationwide created what he described as a “confluence page” to share information about bad actors among themselves. For consumers, Navarro said, regulators are considering creating a public search tool to search for complaints against health insurance brokers, similar to the BrokerCheck tool created by the Financial Industry Regulatory Authority to oversee securities brokers.

For now, he suggests working with healthcare navigatorsthat help consumers purchase plans through the official health insurance market, Additionally, regulators have taken legal action over misleading sales tactics. In August, the Federal Trade Commission earned $100 million in refunds for consumers, he said he was “cheated” into bogus health plans. Last year, the Massachusetts attorney general won $515,000 in consumer relief of an insurance company accused of deceptive marketing practices.

Court filings from October indicate the California attorney general is investigating Jericho Share — the health care sharing department Kelly Macauley said she unwittingly purchased a plan from — to see if it meets state requirements. in shared health care ministries.

Jericho Share spokesman Hubbard said the organization was “responding appropriately” to the attorney general’s investigation.

Macauley contacted KHN after reading a June survey about consumers who said they thought they were buying insurance only to find out later that they had been sold memberships in this health care sharing ministry.

Hubbard noted that since this story was published, Jericho Share automatically provides 72-hour refunds for new consumers who request one within 30 days of signing up, no longer allows “outsourced marketing for signups,” and added a member guide and pop-up to their website that Jericho Share is a health care sharing ministry.

The company responded online to Macauley’s bad review on the Better Business Bureau website, asking for more information about his case. She said she provided this information but never heard back.

After Macauley unsuccessfully tried to directly cancel her Jericho Share plan with the company, she said, she called her credit card company to stop it from approving any further charges from the society. When she described her situation, Macauley said, the friendly credit card representative told her, “It’s a fraud” and offered to try and collect all of her bonuses.

Even if this effort succeeds, Macauley will end up with the tens of thousands of dollars in medical bills she unknowingly incurred while uninsured.

She is new to the health insurance market and is considering choosing a company she has heard of before.

“Whatever it takes,” Macauley said, “I just want to know that I really have insurance.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

Copyright 2022 Florida Health News


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